Walk off back pain?

By Dan Robbins, MD
Fellowship-trained spine surgeon in Vermont

As pointed out recently in the national best seller Born to Run, the human race evolved to walk and run in an upright position with appropriate balance. That balance is easily disturbed by many factors including age, weight distribution and deconditioning.

The alteration of normal posture and subsequently alignment leads to a variety of orthopaedic problems from spine pain to plantar fasciitis and other lower extremity disorders which account for personal misery and suffering.

The medical community as a whole has been taught to identify a diagnosis and treat said diagnosis with medications, passive and active exercise that is focal and not routinely applicable to daily life, and surgical interventions.

The vast majority of mechanical complaints are additionally met with the assurance from health care professionals that the symptoms will eventually get better. This understanding of the natural history (what happens if you do nothing) unfortunately does not allow the individual to understand, or correct intrinsic changes in their body that will eventually lead to more chronic and less easily treated problems when we start using our bodies “gears” (or joints) in an inappropriate manner.

Over the last 28 years of training and practicing orthopaedic care both with surgical and non-surgical techniques, I have strived to minimize aggressive surgical intervention and its imperfect answers to multiple mechanical and neurological conditions.

The key to our ability as a species to prevent or correct these speed bumps on the road of life are found in the understanding of the source of these pains and thereby the insight to understand, demystify and reduce the inherent stress associated with their onset in our lives.

An analogy that may make sense is when you have a charley horse in the calf. We all know from experience that teh best way to rapidly address this pain is by walking off the cramp and stretching.

But when it comes to back pain, we effectively walk on our proverbial tip toes trying to decrease the pain rather than reduce the body’s normal response to abnormal motion/stress, thereby prolonging the symptoms and not correcting the source. In other words, with the Charley Horse analogy, what if we could put the back in a neutral position that begins to lessen back pain naturally.

The understanding of what neutral position is for each individual and how to achieve it in daily life both for standing and sitting, or during athletic endeavors, is crucial.

This need is seen in the issue that most people deal with in the face of back and lower extremity degenerative changes with pain is the experience of pain in transitions (sitting to standing as an example) between activities. The underlying source of this type of pain is a general diminishment of motion in response to pain and stiffness that creates a tearing or ripping phenomena that the body identifies as abnormal.

The analogy I use frequently is that if you were to clench your hand in a fist, comparable to shortening the capsules of the mobile finger-like joints of the spine (facet joints) for 30 minutes you would literally pull the fingers open to achieve relief.

The same is true for your spine as the tightening of the joints shorten the length of your muscles, already in spasm. Creation of normal motion throughout the day, almost comparable to wiggling your fingers/toes or breathing needs to be ingrained to both desensitize the irritated tissues and diminish the daily stress one applies to our spine if not properly cared for.

Techniques taught such as the Alexander method allow one to apply these above-mentioned basic premises to control gravity’s consistent downward pressure on our body (noting how activities in water where we are buoyant are not painful routinely). Interventions including exercise demonstrated by both health care and exercise professionals including yoga and Pilates clearly help to reconnect you to the bodies’ language.

Unfortunately like any bodily function you cannot expect long-term benefit unless there is a continuous interaction with your body just as you would check your dashboard or side view mirrors while driving a car.

Given a better understanding about your body’s signals, there can be a significant diminishment of pain and anxiety associated with many common symptoms encountered.

Surgical and nonsurgical care results are linked to decision-making in identifying the source of the pain. The use of selective blocks for both diagnostic and therapeutic benefits can help discern the path of treatment. The information obtained from responses to both the pain management blocks and self directed application the above mentioned mechanical adjustments is absolutely needed by anyone facing the prospect of a surgical answer to neurologic /mechanical pain.

Many of us are able to recall acquaintances and loved ones with less than ideal results from surgical interventions. Although there are known complications from any surgical intervention there is usually a common link. Lack of true understanding about the source of pain and the long term consequences of surgical intervention including standard techniques that create collateral injury for an otherwise appropriate surgical plans lead to less than ideal results seen nationally.

The appropriate application of minimally invasive spinal techniques, used in surgical intervention that is needed in the face of failed conservative care and persistent pain/ dysfunction is a topic best left for another article.

Returning to the best selling book that we previously mentioned, Born to Run has spawned a renewed interest in barefoot running, as we have discovered that supportive running shoes do not decrease the incidence of running injury. In fact there is clear indications that the opposite phenomena is occurring. The basis of this increase is linked to diminished tactile feedback runners perceive with these significantly padded sneakers. Heel strike while running or walking leads to increase extension of you knee as well as increased arching of your spine, which substantially increase forces propagated across these and other joints.

The same phenomena can be seen in daily issues of postural awareness and core strength use as it applies to spinal pain. This may seem to be more of a philosophical or mystical approach to a concrete problem, but in truth pain and its effect on our lives are deeply intertwined with daily stress and perceptions. The control of these parameters can only be achieved with an understanding of what our personal dashboard is telling us. A comprehensive and informative interaction with your spine care specialist is the not just about a diagnosis and what that person will do for you. Paraphrasing President John F. Kennedy; ask not what your body can do for you, but what you can do for your body.

Our spine center offices serve all of Vermont, including the communities of Burlington, Bennington, Rutland, Manchester, Barre, and Montpelier, upper New York state including Saratoga Springs and Queensbury, New Hampshire and Massachusetts.

Disclaimer:

The pictures displayed in www.TaconicSpine.com are images of physicians, patients and employees who have consented to have their pictures in this website.

You might be surprised to learn that 80 percent of the time, back and neck pain is simply a result of strain or soft tissue injury. Click here to learn about the different conditions related to neck and back pain and how to relieve symptoms through treatment.

One of Vermont’s most innovative spine surgeons, Dr. Robbins specializes in minimally invasive back surgery and regularly teaches new techniques for spine surgery at clinics around the country. His medical degree was received at Howard University, followed by his internship completed at St. Vincent’s Medical Center. He received his fellowship training at the University of Hong Kong in Spine and Pediatric Surgery. Click here to learn more.

The vast majority of back problems improve on their own or with nonsurgical treatment. There are a few warning signs, however, that may indicate serious spinal problems. Weakness or numbness in a leg or arm, especially if it is severe—and it is getting worse—also points to nerve damage. Nerve damage associated with these symptoms can be permanent if not treated immediately. Numbness, pain or tingling that radiates into the arm or leg is also a source for concern and should be seen within a few days by a spine specialist.

Click here to learn more about what symptoms mean and when to see a doctor.

The vast majority of back problems improve on their own or with nonsurgical treatment. There are a few warning signs, however, that may indicate serious spinal problems. Please take a moment to view frequently asked questions that can help you understand pain symptoms.

Dr. Rob Giering specializes in developing non-surgical treatment options for back and neck pain patients, including the use of customized spine therapy techniques and spinal injections that relieve inflammation around nerve roots. These injections enable many patients to resolve their symptoms without the need for surgery. Click here to learn more.

Taconic Spine emphasizes activity as the key to relief from back and neck pain. The Vermont spine center mails out a free 36-page Home Remedy Book for back pain and neck pain with pain-relieving stretches that can be done on the living room rug while watching TV. These customized exercises make the back stronger, more flexible and resistant to injury. Click here to learn more.

New minimally invasive spine surgery tools and techniques used by the spine surgeon at Taconic Spine reduce the length of the incision and enables the person to go home quicker and have a less painful recovery.

Recognizing that spine care requires a spine center approach, Taconic Orthopaedics founded Taconic Spine in 2011 as its spine specialty center. For more than 40 years, Taconic Orthopaedics has cared for people in the Vermont region. With seven orthopaedic doctors, it is one of the largest orthopaedic groups in Vermont. It includes board-certified specialists in knee and hip replacement; joint problems; sports medicine and general orthopaedics. Click here to visit the educational Internet site for Taconic Orthopaedics.